| 481. |
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| 482. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic
- 2014
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72, Suppl. 3, s. 139-140
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with chronic inflammatory arthritis (CIA) treated with biological therapy are usually monitored by rheumatologists. Research shows that a nurse-led rheumatology clinic is safe and effective in monitoring biological therapy (1) and contributed added value in patients within rheumatology care, because the encounter with the nurse led to a sense of security, familiarity and participation (2).Objectives: To compare the cost of monitoring biological therapy in a nurse-led rheumatology clinic with those of a rheumatologist-led clinic in patients with low disease activity or in remission.Methods: Cost comparison was based on data from a 12 month randomised controlled trial (1). A total of 107 patients were randomly assigned to either a rheumatologist-led clinic or to a nurse-led rheumatology clinic. The purpose of the intervention was to replace one of two annual monitoring visits at the rheumatologist-led clinic (control group; n=54) by a visit to a nurse-led rheumatology clinic (intervention group; n=53), based on person-centred care. Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. All outpatient visits, team rehabilitation and all the telephone advice at the Rheumatology Clinic were registered for the patients who participated in the trial. Main outcome measures were direct costs related to rheumatology care during the 12 month follow-up period.Results: After 12 months 97 patients completed the study. At the inclusion the patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. There was no mean difference in changes in clinical outcome between the two groups (DAS28 -0.06; p=0.66). The total annual cost of team rehabilitation in rheumatology care, per patient monitored by the nurse-led rheumatology clinic was €580 compared with €1278 for monitoring by a rheumatologist-led clinic, translating in a €698 (55%) lower annual cost. The annual cost of just the outpatient rheumatology care provided by rheumatologist and rheumatology nurse, per patient was €457 for monitoring by the nurse-led rheumatology clinic compared with €598 for monitoring by a rheumatologist-led clinic, translating in a €141 (24%) lower annual cost.Conclusions: Patients with stable CIA undergoing biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic compared to a rheumatologist-led clinic, with no difference in clinical outcome as measured by DAS28.ReferencesLarsson et al. (2014). Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs, 70(1): 164-175.Larsson et al. (2012). Patients’ experiences of a nurse-led rheumatology clinic in Sweden – a qualitative study in patients undergoing biological therapy. Nurs Health Sci, 14(4): 501-507.
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| 483. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Biological therapy could be monitored by a rheumatology nurse-led clinic without any differences in outcome – a randomised controlled study
- 2012
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Konferensbidrag (refereegranskat)abstract
- Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients who are in low disease activity or remission.Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a rheumatology nurse (intervention group; n=53) or to a rheumatologist (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. After 12 months 97 patients completed the study. Main outcome was disease activity measured by DAS28.Results: Patients had mean age of 55.4 years and disease duration of 16.7 years. DAS28 was 2.1. At inclusion there were no significant differences in DAS28 between the groups. There were no differences (p=0.67) in change of DAS28 between the intervention group (0.14) or control group (0.20) from inclusion to 12 months.Conclusions: In patients with low disease activity biological therapy could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.
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| 484. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Nurse-led rheumatology clinic versus rheumatologist clinic in monitoring of biological therapy– a randomised controlled study
- 2012
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 71:Suppl. 3, s. 121-121
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission.Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a nurse-led rheumatology clinic (intervention group; n=53) or to a rheumatologist clinic (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. Main outcome was disease activity measured by DAS28.Results: After 12 months 97 patients completed the study. The patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. In change of DAS28 there were no differences (p=0.66) between the intervention group (0.14) or control group (0.20) from inclusion to 12 months. There were no differences (p>0.05) in mean change after 12 months in ESR, swollen and tender joints, global health and pain visual analogue scales (VAS) or Health Assessment Questionnaire (HAQ) between the patients followed up at the nurse-led rheumatology clinic or the rheumatologist clinic, see table. Table. Comparison of the two groups intervention group (Nurse-led rheumatology clinic) and control group (Rheumatologist clinic).
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| 485. |
- Larsson, Ingrid, et al.
(författare)
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Patients’ experiences of nurse-led follow-up in biological therapy – a qualitative study
- 2011
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Konferensbidrag (refereegranskat)abstract
- Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patients may require biological therapy. These patients usually have rheumatologist follow-up twice a year. Nurse-led clinics have been proposed for patients treated with biological therapy that are in low disease activity or remission (Disease Activity Score, DAS <3.2). In an ongoing study at a Swedish rheumatology clinic every other rheumatologist follow-up has been replaced by a rheumatology nurse-led follow-up. At the nurse-led follow-up the patients' disease activity is assessed by examining tender or swollen joints and laboratory tests.Objectives: The purpose of this study was to describe patients' experiences of nurse-led follow-up in biological therapy.Methods: The study had a descriptive design with a qualitative content analysis approach. In qualitative content analysis the interpretations vary in depth and level of abstraction: the manifest content describes the visible, what the text says and creating categories, the latent content involves an interpretation of the underlying meaning of the text, what the text talks about and creating a theme. Seventeen interviews were conducted based on a strategic sampling in order to achieve variation in experiences of nurse-led follow-up in terms of sex, age, civil status, education, duration of disease and therapy and ways of administration.Results: The content analysis of the interviews resulted in the theme "The rheumatology nurse promotes patients with added value" which was based on four categories: familiarity, security, availability and participatory: Familiarity meant that it was easier to ask the rheumatology nurse about disease, treatment and how to live with a chronic disease than the rheumatologist. Patients experienced security in the rheumatology nurse's knowledge and skill. Availability meant that it was easy to contact the rheumatology nurse who spent time to patients' needs. Patients experienced being participatory in their biological therapy and in the rheumatology nurse's examination of the disease activity.Conclusions: The rheumatology nurse follow-up resulted in that patients experienced familiarity, security, availability and being participatory in their biological therapy. The rheumatology nurse promoted patients from another perspective, than the rheumatologist, in the rheumatology care. By replacing every other rheumatologist follow-up with a rheumatology nurse-led follow-up for patients with biological therapy, who are in low disease activity or remission, the rheumatology care will be more complete. A rheumatology nurse and a rheumatologist have different perspectives and complement each other. When patients are given the opportunity to meet both professions regularly they are able to receive optimal rheumatology care.Disclosure of Interest: None DeclaredCitation: Ann Rheum Dis 2011;70(Suppl3):755
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| 486. |
- Larsson, Ingrid, et al.
(författare)
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Patients’ experiences of rheumatology nurse-led clinic in biological therapy – a qualitative study
- 2011
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Konferensbidrag (refereegranskat)abstract
- Bakgrund Nurse-led clinics have been proposed for patients with rheumatic diseases treated with biological therapy who are in low disease activity or remission (Disease Activity Score, DAS <3.2). In an ongoing study at a Swedish rheumatology clinic every other rheumatologist follow-up has been replaced by a rheumatology nurse-led follow-up. At the nurse-led follow-up the patients´ disease activity is assessed by examining tender or swollen joints and laboratory tests. The purpose of this study was to describe patients´ experiences of rheumatology nurse-led follow-up in biological therapy.Metod The study had a descriptive design with a qualitative content analysis approach. Strategic sampling was carried out in order to achieve variation in experiences of nurse-led follow-up. Interviews were conducted with 20 patients (10 males and 10 females, 10 i.v infusions and 10 s.c injections as way of administration, 34-76 years of age, and duration of illness 3-41 years).Resultat The content analysis of the interviews resulted in the theme "The rheumatology nurse promotes patients with added value" Which was based on four categories: familiarity, security, availability and participatory: Familiarity meant that it was easier to ask the rheumatology nurse about disease, treatment and how to live with a chronic disease than the rheumatologist. Patients experienced security in the rheumatology nurse’s knowledge and skill. Availability meant that it was easy to contact the rheumatology nurse who spent time to patients' needs. Patients experienced being participatory in the biological therapy and in the rheumatology nurse’s examination of the disease activity.Sammanfattning The rheumatology nurse-led follow-up resulted in that patients experienced familiarity, security, availability and being participatory in their biological therapy. The rheumatology nurse promoted patients from another perspective, than the rheumatologist. By replacing every other rheumatologist follow-up with a rheumatology nurse-led follow-up for patients with biological therapy, who are in low disease activity or remission, the rheumatology care will be more complete. A rheumatology nurse and a rheumatologist have different perspectives and complement each other. When patients are given the opportunity to meet both professions regularly they are able to receive optimal rheumatology care.
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| 487. |
- Larsson, Ingrid, et al.
(författare)
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Patients’ independence of a nurse for the administration of their subcutaneous anti-TNF therapy : A phenomenographic study
- 2010
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Konferensbidrag (refereegranskat)abstract
- Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of subcutaneous injections by patients themselves. It is therefore important that the patient perspective is focused upon the life-changing situation due to the administration of regular subcutaneous injections.Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases conceive their independence of a nurse for the administration of their subcutaneous anti-TNF therapy.Methods: The study had a descriptive qualitative design with a phenomenographic approach. Twenty interviews were conducted based on a strategic sampling in order to achieve variation in conceptions of the phenomenon in terms of sex, age, marital status, education, illness duration, duration of medication, distance between home-hospital, and experience of intravenous infusions.Results: Four descriptive categories emerged: 1. Struggling for independence: The patients experienced a struggle and limitations in their lives by the self-administration of the subcutaneous injections. 2. Learning for independence: Patients experienced a learning process by the self-administration of the subcutaneous injections. 3. Participating for independence; Patients experienced control over their lives by themselves administers the subcutaneous injections. 4. Freedom through independence: Patients experienced that they could manage their lives and live as independently as possible by the self-administration of the subcutaneous injections.Conclusion: Independence of a nurse at the subcutaneous anti-TNF injections is a process. There is a striving for independence in which patients are taking themselves further by learning and participating in drug treatment and then experience the injection provides independence. Patients under treatment with subcutaneous anti-TNF injections are at different phases in the process of independence; this is not depending on how long they have self-administered subcutaneous injections.Disclosure of Interest: None declaredCitation: Ann Rheum Dis 2010;69(Suppl3):730Nursing
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| 488. |
- Larsson, Ingrid, et al.
(författare)
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Patients with rheumatic diseases and their conceptions of regular self-administered subcutaneous anti-TNF injections
- 2010
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Konferensbidrag (refereegranskat)abstract
- Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of subcutaneous injections by patients themselves. It is therefore important that the patient perspective is focused upon the life-changing situation due to the administration of regular subcutaneous injections.Aim: The aim of this study was to describe variations in how patients with rheumatic diseases experience the self-administration of their subcutaneous anti-TNF therapy.Methods: The study had a descriptive qualitative design with a phenomenographic approach. Twenty interviews were conducted based on a strategic sampling in order to achieve variation in conceptions of the phenomenon in terms of sex, age, marital status, education, illness duration, duration of medication, distance between home-hospital, and experience of intravenous infusions.Results: Four descriptive categories emerged: 1. The struggling patient: The patients experienced a struggle and limitations in their lives by the self-administration of the subcutaneous injections. 2. The learning patient: Patients experienced a learning process by the self-administration of the subcutaneous injections. 3. The participating patient: Patients experienced control over their lives by themselves administers the subcutaneous injections. 4. The independent patient: Patients experienced that they could manage their lives and live as independently as possible by the self-administration of the subcutaneous injections.The administration of regular subcutaneous anti-TNF injections is a process. The striving for independence in which patients are taking themselves further by learning and participating in drug treatment and then experience that the injection provides independence. Patients under treatment with subcutaneous anti-TNF injections are at different phases in the process of independence; this is not depending on how long they have self-administered subcutaneous injections.
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| 489. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Sjuksköterskemottagning för patienter med en reumatisk sjukdom behandlade med biologiska läkemedel – ett randomiserat, kontrollerat försök jämförande sjuksköterskemottagning med läkarmottagning
- 2012
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Konferensbidrag (refereegranskat)abstract
- Bakgrund Målet med behandling av reumatiska sjukdomar är att ta kontroll över ledsmärta och svullnad, reducera ledskador samt förebygga funktionsnedsättningar. För patienter med otillräcklig respons på traditionella läkemedel har forskningen inom reumatologin varit av stor betydelse och medfört utveckling av biologiska läkemedel. Behandling med biologiska läkemedel för patienter med reumatisk sjukdom följs vanligtvis upp av en reumatolog. För patienter som är lågaktiva i sin sjukdom eller i remission har uppföljning via en sjuksköterskemottagning föreslagits. Syfte var att jämföra sjuksköterskemottagning med läkarmottagning avseende behandlingsresultat för patienter behandlade med biologiska läkemedel med låg eller ingen sjukdomsaktivitet.Metod Ett randomiserat kontrollerat öppet försök med 12 månaders uppföljning genomfördes mellan oktober 2009 och augusti 2011. Avsikten var att ersätta ett av de två årliga läkarbesöken med ett sjuksköterskebesök. En sjuksköterskemottagning utformades utifrån en personcentrerad vård med patientens behov i fokus. Inklussionskriterier var patienter med en reumatisk sjukdom behandlade med biologiskt läkemedel och en sjukdomsaktivitet, Disease Active Score 28 (DAS28) ≤3.2. Av 107 patienter randomiserades 53 patienter till uppföljning av sjuksköterska och 54 patienter till uppföljning av läkare. Hypotesen var att behandlingsresultatet på en sjuksköterskemottagning inte skulle vara sämre än på en läkarmottagning vid 12 månaders uppföljning. Huvudutfallsmått var DAS28.Resultat Efter 12 månader hade 47 patienter i sjuksköterskegruppen och 50 patienter i läkargruppen fullföljt studien. Patienterna hade en medelålder på 55.4 år, sjukdomsduration på 16.7 år och DAS28 var 2.1. Det fanns ingen statistiskt signifikant skillnad mellan grupperna. Efter 12 månader var det inte någon statistisk signifikant skillnad (p=0.66) i förändring av DAS28 mellan sjuksköterskegruppen (0.14) eller läkargruppen (0.20). I utfallsmåtten sänka, svullna och ömma leder, global hälsa och smärta (VAS) eller Health Assessment Questionnaire (HAQ) var det inte heller någon statistisk signifikant skillnad i förändring efter 12 månader mellan grupperna. Båda grupperna var lika nöjda med vården och säkra på att få hjälp från reumatologmottagningen vid problem med lederna.Sammanfattning Patienter med en stabil reumatisk sjukdom behandlade med biologiskt läkemedel kan följas upp vid en sjuksköterskemottagning utan någon skillnad i behandlingsresultat med avseende på DAS28.
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| 490. |
- Larsson, Ingrid, 1968-, et al.
(författare)
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Treatment Outcomes From a Nurse-Led Rheumatology Clinic in Monitoring of anti-TNF Therapy – a Randomised Controlled Trial
- 2012
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Ingår i: Arthritis and Rheumatism. - Hoboken, NJ : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 64:10, s. S667-S667
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with chronic inflammatory arthritis (CIA) treated with anti-TNF therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission. The purpose of this trial was to compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients undergoing anti-TNF therapy with low disease activity or in remission.Methods: A randomized controlled trial (RCT) with a 12-month follow-up was conducted with 107 patients randomised into two groups with a 6-month follow up to a nurse-led rheumatology clinic based on a person-centred care (intervention group; n=53) or to a rheumatologist-led clinic (control group; n=54). The intention of the interventional trial was to replace one of the two annual rheumatologist monitoring visits by a nurse-led rheumatology monitoring visit for patients undergoing anti-TNF therapy. Inclusion criteria were patients undergoing anti-TNF therapy and Disease Activity Score 28 (DAS28) ≤3.2. The hypothesis was that the outcomes from nurse-led clinic will not be inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. Primary outcome was disease activity measured by DAS28.Results: After 12 months 47 patients in the intervention group and 50 patients in the control group completed the trial and there were no differences (p=0.66) in mean change of DAS28 between the intervention or control group. There were no differences (p>0.05) in mean change in Visual Analogue Scales (VAS) for pain, Health Assessment Questionnaire (HAQ), satisfaction or security with the rheumatology care between the two groups, see table.Conclusion: In monitoring of anti-TNF therapy treatment outcomes for patients at a nurse-led rheumatology clinic are not inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. The follow-up care of anti-TNF therapy may advantageously be performed by a nurse-led clinic based on a person-centred care. The results from this trial demonstrated that patients with CIA undergoing anti-TNF therapy, with low disease activity or in remission, could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.
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